Healthcare.gov is supposed to use these fees to fund operations. It pays for the server racks. It pays for the Help Desk. It pays for file loads. It pays for advertising. It pays for outreach. The fees are designed to make the system work well.

However over the past two years, advertising has been slashed. Navigator funding is a figment of the imagination now. Open Enrollment is half the time it used to be. On-Exchange enrollment has barely moved down since 2017 even as average premiums have increased significantly due to the termination of Cost Sharing Reduction (CSR) payments which is then looped into silver premiums and general medical trend. The total premium going through Healthcare.gov has increased significantly without a concurrent increase in opeational expenses or outreach.

We know that more revenue should be hitting the federal accounts for Healthcare.gov user fees. We know that outreach expenses have been slashed. So where is the money that is not being visibly spent compared to 2017? Is it just sitting in an account? Or did someone get a no bid PR contract to talk down the ACA? Where is the moola?

FSM bless em, but I’m on record as one of the first (only?) people who ever had to argue with California that we Shouldn’t have been on MediCal. Because Covered California – in spite of repeated calls from me – kept sending us there. To the point when we had an actual telephone hearing with a Real Judge, to basically establish that we’d never applied for Medical, we had insurance, we weren’t eligible for Medical… I AM NOT MAKING THIS UP.

It was insane. Fortunately, I had my emails to Covered California, and importantly, their actual records of my calls… And basically, the Judge looked at all of it, said *hint* I’m ruling that Mr S, in his stroke event, was totally covered by Medical, because Covered California fucked up big time, so Covered CA has to deal with it.

Covered CA? Most of the ppl I talked with on the phone were so bright – over and over again, ppl on the phone would “see the problem” and send a fix… it was so not their fault. Hello, IT? Fuck you.

And if the default is to cover people who are marginal? Fucking Yes, if my adopted state goes out of its way to cover everyone they can, I approve.